Gainesville VA paid out $5 million in wrongful death cases

Published: Saturday, June 21, 2014 at 5:54 p.m.

Last Modified: Saturday, June 21, 2014 at 5:54 p.m.

The Gainesville VA hospital paid the most in settlements for wrongful death cases among Florida's VA medical centers in the decade after 9/11 and had the second-highest number of settled cases.

Bradley Bender, chief of staff for the North Florida/South Georgia Veterans Health System, pointed to the local VA's size as the main factor for why Gainesville's figures for wrongful death cases were higher than most of its sister facilities in the Sunshine State.

The North Florida/South Georgia system is the largest VA health system in the United States, he said. It has the largest number of patients of all the VA medical centers in Florida, and Gainesville's VA hospital is far and away the largest provider to veterans in the North Florida/South Georgia system.

The North Florida/South Georgia system, which also includes the Lake City VA medical center, serves around 125,000 unique patients per year.

"I think this is actually a relatively small number of payouts considering the size of our system," he said. "It explains why we have more than our sister facilities throughout the state."

The Center for Investigative Reporting obtained data on wrongful death cases at VA medical centers across the nation and found the U.S. Department of Veterans Affairs made around $200 million in wrongful death payments to almost 1,000 families in the decade after Sept. 11, 2001.

The Malcom Randall VA Medical Center in Gainesville made $5,067,000 in wrongful death payments during that time, which was more than each of the VA medical centers at Bay Pines, Lake City, Miami, Orlando, Tampa and West Palm Beach.

The Gainesville hospital paid that $5 million collectively for a total of 16 wrongful death cases. Only the James A. Haley Veterans Hospital in Tampa had a higher number of settled cases, with 18 cases totaling about $3.3 million in wrongful death payments.

The Lake City medical center, which operates within the same health system as the Gainesville hospital, made $513,900 in payouts for a total of four wrongful death cases, according to the Center for Investigative Reporting.

Most of the wrongful death payments for the Gainesville and Lake City facilities were made through the agency's administrative process. Only six of Gainesville's 16 cases resulted in payments made after the veteran's survivors had filed a federal lawsuit.

Of those 16 Gainesville cases, "failure to diagnose" was listed as a type of malpractice involved in seven cases, according to the Center for Investigative Reporting. "Delay in treatment" was listed for three cases, while "failure to order appropriate medication" and "wrong procedure or treatment" were each listed in two cases.

Other types of malpractice involved in the Gainesville cases included singular instances of a wrong diagnosis or misdiagnosis and a radiology or imaging error, among other types of malpractice.

Bender told The Sun he couldn't comment on specific cases.

He did say the Gainesville hospital has cardiac and neurosurgery units, which aren't provided at all VA hospitals and involve high-risk procedures.

Bender also said settlement decisions are made by lawyers who think it is the best course of action. For example, they may feel the VA could be in danger of losing more money if the case goes to federal court.

Just because there's a settlement doesn't mean there has been an admission of guilt on the part of the VA hospital, he said.

However, any patient's death is concerning, Bender said. All unexpected deaths are reviewed and corrective action is taken whenever the VA finds room to improve.

Additionally, any time there's a settlement against a licensed practitioner, the agency is required to send the facts of the case to the VA's Office of Medical-Legal Affairs for an outside review.

People pursuing wrongful death cases must first go through the VA's administrative process before filing a federal lawsuit, according to Mike Allen, a law professor and director of the Veterans Law Institute at Stetson University. Another option, though, would be to file a related benefits claim.

Malpractice-related benefits claims involving a wrongful death case are going to account for a small amount of the roughly 1.3 million claims for benefits the VA processes per year, Allen explained. The Veterans Law Institute may even see people seeking benefits for wrongful death cases.

"It's not like a unicorn — it actually exists — but it's more like a three-legged dog," he said. "You're not going to see one every day."

There are always going to be more cases than those that are actually filed, but it's exceedingly difficult to quantify that, Allen said. People may not pursue a wrongful death case because it's too painful, for example, or it may be harder to find lawyers willing to take on this type of case.

It's hard to determine if this data demonstrates a problem involving wrongful death cases in Gainesville because each unit of the VA is, in many respects, operating independently because the federal agency is so big, Allen said.

The real trick is separating the negative outcomes that are literally just mistakes due to human error from those that stem from a systemic problem, such as a lack of training or cleanliness in a medical facility, Allen said. Systemic problems can be fixed, he added.

"That is why litigation is often a very poor means of reform," Allen said. "If I'm representing you in a malpractice claim against the VA, my goal is simply to get you the best recovery I can get you, and if I can get that without going into all the stuff about systemic problems, I'm going to do that, right?"

The data collected on VA wrongful death cases is useful but raises more questions than it will answer in some respects, Allen said.

VA issues have always been prominent politically, but the recent scandal over how long veterans have to wait to get appointments at VA facilities across the country has made the VA's issues stand out, he said. It has led to more scrutiny of the VA, and getting this data on wrongful death cases is just another step in that process.

"It's not going away and it's certainly not going away in a year when we've got big elections," Allen said.

The Gainesville VA hospital attracted scrutiny in May when a handwritten waiting list of more than 200 mental health patients was found. It was a list of established patients in need of follow-up appointments, according to VA personnel.

Three employees were put on administrative leave right after the list surfaced but were brought back to work in late May. The director of the North Florida/South Georgia system, Thomas Wisnieski, has said the list wasn't a secret waiting list like those allegedly found at other VA facilities.

Scott Camil, president of the local chapter of Veterans for Peace, said he is completely satisfied with the care he receives from the Gainesville VA but was surprised to find his chapter's membership is divided.

During a recent meeting, he asked how many people were satisfied with the Gainesville VA and half their hands went up while the other half raised their hands when he asked who wasn't satisfied.

"Our membership is mixed," he said. "We have some people who are very happy with their care and some people who are very unhappy with their care."

George "Denny" Bellesheim, one of Camil's fellow Veterans for Peace members, has mixed feelings about the Gainesville VA hospital based on his experience there.

The hospital's ICU staff saved his life a couple of years ago when he began throwing up blood due to a tear in his esophagus, he said. But he also spent three years going to the VA to try to get a diagnosis for a recurring medical problem before eventually seeking outside help because the VA staff couldn't determine what was wrong with him.

For about three years, he'd have episodes where his whole body would suddenly start shivering and he'd bundle up in warm clothes, eventually fall asleep and wake up exhausted. It usually took him two days to bounce back from these episodes, he said.

He lost weight, dropping from 220 pounds to 160 pounds, and had trouble walking.

"I was dying and I knew that in my mind," he said. "They're not finding something and I'm dying, you know …"

When he finally went to see a doctor outside the VA, the physician and a specialist figured out what was wrong with him in a matter of days and treated him for it immediately.

It turned out he had stones that had fallen into his lower bile duct, blocking it, Bellesheim said. Bile was backing up and he was essentially poisoning himself.

It took at least four months once to get an appointment at the Gainesville VA to run another test on him, Bellesheim said. "They should have been able to figure it out," he said.

His primary care doctor at the Gainesville VA hospital was kind but unsatisfactory, Bellesheim said. He informed a patient advocate of his concerns but was told they get complaints about every doctor.

Bellesheim said he felt like he was just another complaint to put in the file and forget about.

Bender, chief of staff for the North Florida/South Georgia system, said complaints about a primary care provider usually lead to a patient being assigned to a different physician if the issue can't be resolved otherwise.

Most of the complaints about specific doctors are due to miscommunication, not bad care, Bender said. The VA tracks concerns about providers.

Patient advocates always communicate with the appropriate supervisors whenever they get a complaint about a physician, so some actions may be taken behind the scenes that patients aren't aware of, Bender said.

Bender said they aren't allowed to disclose disciplinary actions to the public because of employee privacy considerations.

Bellesheim told The Sun he hasn't pursued a malpractice claim. His main concern is about the doctor with whom he had such a bad experience as a patient.

"I mean I know she didn't pick me out to give me bad treatment, so how many other veterans is she not giving proper treatment to?" he asked.

Any case of the wrongful death of a patient is a shame, Bellesheim said. "It should never happen, whether it's at the VA or anywhere else. Being a veteran, I do feel that we were promised that we were going to be taken care of and we assumed that that meant we'd have good health care," he said. "Unfortunately, I don't think it's as good as it could be, and I think part of the problem is funding."

<p>The Gainesville VA hospital paid the most in settlements for wrongful death cases among Florida's VA medical centers in the decade after 9/11 and had the second-highest number of settled cases.</p><p>Bradley Bender, chief of staff for the North Florida/South Georgia Veterans Health System, pointed to the local VA's size as the main factor for why Gainesville's figures for wrongful death cases were higher than most of its sister facilities in the Sunshine State.</p><p>The North Florida/South Georgia system is the largest VA health system in the United States, he said. It has the largest number of patients of all the VA medical centers in Florida, and Gainesville's VA hospital is far and away the largest provider to veterans in the North Florida/South Georgia system. </p><p>The North Florida/South Georgia system, which also includes the Lake City VA medical center, serves around 125,000 unique patients per year.</p><p>"I think this is actually a relatively small number of payouts considering the size of our system," he said. "It explains why we have more than our sister facilities throughout the state."</p><p>The Center for Investigative Reporting obtained data on wrongful death cases at VA medical centers across the nation and found the U.S. Department of Veterans Affairs made around $200 million in wrongful death payments to almost 1,000 families in the decade after Sept. 11, 2001.</p><p>The Malcom Randall VA Medical Center in Gainesville made $5,067,000 in wrongful death payments during that time, which was more than each of the VA medical centers at Bay Pines, Lake City, Miami, Orlando, Tampa and West Palm Beach.</p><p>The Gainesville hospital paid that $5 million collectively for a total of 16 wrongful death cases. Only the James A. Haley Veterans Hospital in Tampa had a higher number of settled cases, with 18 cases totaling about $3.3 million in wrongful death payments.</p><p>The Lake City medical center, which operates within the same health system as the Gainesville hospital, made $513,900 in payouts for a total of four wrongful death cases, according to the Center for Investigative Reporting.</p><p>Most of the wrongful death payments for the Gainesville and Lake City facilities were made through the agency's administrative process. Only six of Gainesville's 16 cases resulted in payments made after the veteran's survivors had filed a federal lawsuit.</p><p>Of those 16 Gainesville cases, "failure to diagnose" was listed as a type of malpractice involved in seven cases, according to the Center for Investigative Reporting. "Delay in treatment" was listed for three cases, while "failure to order appropriate medication" and "wrong procedure or treatment" were each listed in two cases.</p><p>Other types of malpractice involved in the Gainesville cases included singular instances of a wrong diagnosis or misdiagnosis and a radiology or imaging error, among other types of malpractice.</p><p>Bender told The Sun he couldn't comment on specific cases. </p><p>He did say the Gainesville hospital has cardiac and neurosurgery units, which aren't provided at all VA hospitals and involve high-risk procedures.</p><p>Bender also said settlement decisions are made by lawyers who think it is the best course of action. For example, they may feel the VA could be in danger of losing more money if the case goes to federal court.</p><p>Just because there's a settlement doesn't mean there has been an admission of guilt on the part of the VA hospital, he said.</p><p>However, any patient's death is concerning, Bender said. All unexpected deaths are reviewed and corrective action is taken whenever the VA finds room to improve.</p><p>Additionally, any time there's a settlement against a licensed practitioner, the agency is required to send the facts of the case to the VA's Office of Medical-Legal Affairs for an outside review. </p><p>People pursuing wrongful death cases must first go through the VA's administrative process before filing a federal lawsuit, according to Mike Allen, a law professor and director of the Veterans Law Institute at Stetson University. Another option, though, would be to file a related benefits claim.</p><p>Malpractice-related benefits claims involving a wrongful death case are going to account for a small amount of the roughly 1.3 million claims for benefits the VA processes per year, Allen explained. The Veterans Law Institute may even see people seeking benefits for wrongful death cases.</p><p>"It's not like a unicorn — it actually exists — but it's more like a three-legged dog," he said. "You're not going to see one every day." </p><p>There are always going to be more cases than those that are actually filed, but it's exceedingly difficult to quantify that, Allen said. People may not pursue a wrongful death case because it's too painful, for example, or it may be harder to find lawyers willing to take on this type of case.</p><p>It's hard to determine if this data demonstrates a problem involving wrongful death cases in Gainesville because each unit of the VA is, in many respects, operating independently because the federal agency is so big, Allen said.</p><p>The real trick is separating the negative outcomes that are literally just mistakes due to human error from those that stem from a systemic problem, such as a lack of training or cleanliness in a medical facility, Allen said. Systemic problems can be fixed, he added.</p><p>"That is why litigation is often a very poor means of reform," Allen said. "If I'm representing you in a malpractice claim against the VA, my goal is simply to get you the best recovery I can get you, and if I can get that without going into all the stuff about systemic problems, I'm going to do that, right?"</p><p>The data collected on VA wrongful death cases is useful but raises more questions than it will answer in some respects, Allen said. </p><p>VA issues have always been prominent politically, but the recent scandal over how long veterans have to wait to get appointments at VA facilities across the country has made the VA's issues stand out, he said. It has led to more scrutiny of the VA, and getting this data on wrongful death cases is just another step in that process.</p><p>"It's not going away and it's certainly not going away in a year when we've got big elections," Allen said.</p><p>The Gainesville VA hospital attracted scrutiny in May when a handwritten waiting list of more than 200 mental health patients was found. It was a list of established patients in need of follow-up appointments, according to VA personnel.</p><p>Three employees were put on administrative leave right after the list surfaced but were brought back to work in late May. The director of the North Florida/South Georgia system, Thomas Wisnieski, has said the list wasn't a secret waiting list like those allegedly found at other VA facilities.</p><p>Scott Camil, president of the local chapter of Veterans for Peace, said he is completely satisfied with the care he receives from the Gainesville VA but was surprised to find his chapter's membership is divided.</p><p>During a recent meeting, he asked how many people were satisfied with the Gainesville VA and half their hands went up while the other half raised their hands when he asked who wasn't satisfied.</p><p>"Our membership is mixed," he said. "We have some people who are very happy with their care and some people who are very unhappy with their care."</p><p>George "Denny" Bellesheim, one of Camil's fellow Veterans for Peace members, has mixed feelings about the Gainesville VA hospital based on his experience there. </p><p>The hospital's ICU staff saved his life a couple of years ago when he began throwing up blood due to a tear in his esophagus, he said. But he also spent three years going to the VA to try to get a diagnosis for a recurring medical problem before eventually seeking outside help because the VA staff couldn't determine what was wrong with him.</p><p>For about three years, he'd have episodes where his whole body would suddenly start shivering and he'd bundle up in warm clothes, eventually fall asleep and wake up exhausted. It usually took him two days to bounce back from these episodes, he said. </p><p>He lost weight, dropping from 220 pounds to 160 pounds, and had trouble walking.</p><p>"I was dying and I knew that in my mind," he said. "They're not finding something and I'm dying, you know …"</p><p>When he finally went to see a doctor outside the VA, the physician and a specialist figured out what was wrong with him in a matter of days and treated him for it immediately.</p><p>It turned out he had stones that had fallen into his lower bile duct, blocking it, Bellesheim said. Bile was backing up and he was essentially poisoning himself.</p><p>It took at least four months once to get an appointment at the Gainesville VA to run another test on him, Bellesheim said. "They should have been able to figure it out," he said.</p><p>His primary care doctor at the Gainesville VA hospital was kind but unsatisfactory, Bellesheim said. He informed a patient advocate of his concerns but was told they get complaints about every doctor. </p><p>Bellesheim said he felt like he was just another complaint to put in the file and forget about.</p><p>Bender, chief of staff for the North Florida/South Georgia system, said complaints about a primary care provider usually lead to a patient being assigned to a different physician if the issue can't be resolved otherwise. </p><p>Most of the complaints about specific doctors are due to miscommunication, not bad care, Bender said. The VA tracks concerns about providers. </p><p>Patient advocates always communicate with the appropriate supervisors whenever they get a complaint about a physician, so some actions may be taken behind the scenes that patients aren't aware of, Bender said.</p><p>Bender said they aren't allowed to disclose disciplinary actions to the public because of employee privacy considerations.</p><p>Bellesheim told The Sun he hasn't pursued a malpractice claim. His main concern is about the doctor with whom he had such a bad experience as a patient.</p><p>"I mean I know she didn't pick me out to give me bad treatment, so how many other veterans is she not giving proper treatment to?" he asked.</p><p>Any case of the wrongful death of a patient is a shame, Bellesheim said. "It should never happen, whether it's at the VA or anywhere else. Being a veteran, I do feel that we were promised that we were going to be taken care of and we assumed that that meant we'd have good health care," he said. "Unfortunately, I don't think it's as good as it could be, and I think part of the problem is funding."</p><p><i>Contact Morgan Watkins at 338-3104 or morgan.watkins@gainesville.com.</i></p>